Sexual health – STI infection rates drop, except in gay men

For the first time in ten years, the number of sexually transmitted infections (STIs) diagnosed in England has dropped. Rates of STIs are noticeably lower amongst young people, a group that has generally had high levels of infection with conditions such as chlamydia and gonorrhoea.

However, STI rates have continued to go up at worrying levels amongst gay men and other men who have sex with men. For example, gonorrhoea diagnoses have gone up by a third since 2009 – so that 40% of men with gonorrhoea (and 64% of men with syphilis) were gay men.

The Health Protection Agency (HPA), which produced the figures, says the drop in STI rates is likely to be the result of programmes encouraging people to have sexual health screens.

Looking after your sexual health is important to everybody, but particularly if you have HIV. STIs can not only cause illness, but increase the chances of you passing on HIV during unprotected sex, even if you have an undetectable viral load in your blood.

Although STIs can seem minor, and some cause no symptoms, they can make you ill. If left untreated, some can cause severe and lasting health problems. If you are sexually active, it is wise to have regular sexual health check-ups.

Sexual health – talking about sexual behaviour

The clinical guidelines that set out the levels of care for people with HIV (known as the BHIVA guidelines, developed by a panel of doctors and community advocates) say that people with HIV should have a full sexual history taken every six months. They also suggest that people with HIV should have a full sexual health screen every year.

Researchers looked at the medical records of people attending a London HIV clinic to see if this was happening. They found that a sexual history was taken from 88% of people who had been newly diagnosed with HIV, but only 37% of people coming to the clinic for routine follow-up appointments. The researchers suggest that healthcare workers should do more to assess patients’ risk of passing on HIV and to suggest ways they could reduce that risk.

Talking honestly to healthcare staff is important so they can give you the best possible care. Sexual health clinics should be very used to seeing all the communities affected by HIV in the UK, including gay men and Africans, so the service they offer you should be non-judgemental.

HIV treatment and heart disease

There has been lots of research into whether the anti-HIV drug abacavir (Ziagen) increases the risk of heart and other cardiovascular problems, and the findings of different studies have been contradictory.

Concerns started when a large international study of HIV-positive people found an approximate doubling of the risk of heart attack in those who were taking abacavir. This increased risk is of most concern to people who are already at higher risk of heart attack, because of factors such as a family history of heart disease, high cholesterol levels, smoking or being older.

Some studies since then have found no increased risk, while others seem to confirm a link between abacavir and heart problems.

Now, two new studies have again come up with different findings.

A Danish study showed an increased risk of stroke and other related health problems in people treated with abacavir.

Damage to the immune system was also found to be a key risk factor, with people not on treatment and with a CD4 cell count below 200 at higher risk of heart problems, as were injecting drug users.

Meanwhile, a large American study found no increased risk as a result of taking abacavir. People not on treatment were at highest risk of heart attack. Importantly, this study took into account whether people had a history of kidney disease, which is a known risk factor for heart attack.

The main alternative to abacavir for first-line HIV treatment is tenofovir (Viread). This drug is associated with increased rates of kidney problems. Both sets of researchers recognised that any link between treatment with abacavir and higher rates of heart attack could be because people with known kidney problems are therefore put on to abacavir.

The US research reflected the Danish study in finding that people not on HIV treatment were at increased risk of heart attack and stroke.

Routine HIV care involves regular tests to monitor cardiovascular health, meaning that problems can be spotted early and appropriate action taken.

There’s also a lot you can do to look after your heart – for example not smoking, eating a healthy diet, and exercising regularly – help and advice about all these is available from your HIV clinic or GP.